ABM Presidency Farewell: Breastfeeding Medicine Clarion Call

Published in Volume: 8 Issue 6: December 9, 2013Online Ahead of Print: November 8, 2013

Arthur I. Eidelman

—Arthur I. Eidelman, MD, FABM, FAAP

President, Academy of Breastfeeding Medicine, 2011–2013

Yes, this is my final “Presidential Corner” column, after my 2-year period as President of the Academy of Breastfeeding Medicine, and is customary that at the end of one’s term of office to use this platform to comprehensively summarize both the positive accomplishments and the negative developments that transpired during this period. I choose, however, not succumb to this temptation, but rather jot down some seemingly random thoughts that in the end I hope will serve as a guide, if not an inspiration, for those who follow me in this position.

But first let me retell a Rabbinic homily from the Midrashic literature of the 5th century1:

A king saw an old man digging a hole. He inquired of the old man why he was digging.

“I am digging a hole to plant a tree,” the old man answered.

“How old are you?” queried the king.

“A hundred years old,” responded the tree planter.

“What is the sense of planting a tree when you are 100 years old; you won’t live long enough to eat its fruit,” the king forcefully stated.

The old man replied, “If I am worthy, I shall eat the fruit of the trees; if not, as my father labored for me, I too labor for those who come after me.”

The message is clear! It is not one’s actions for the here and now that guarantee ultimate success, but rather each individual’s toiling away, getting one’s hands dirty, planting the seeds that will bear fruit in the future, while all the time acknowledging that the successes, be they as they may be, rest on our predecessors’ commitment and tireless investment of time and energy. As such, one should envisage oneself as another link in the hope for an ever-expanding chain…or, as a better metaphor, as a transient shepherd for the growing flock of professionals who are committed to the health and well-being of children worldwide through their support of breastfeeding practices.

But enough philosophizing and its attendant risk of being too moralizing. There have been changes, in the past 2 years, for the better, primarily in the developed world. In contrast, the battle to stem the decline in breastfeeding and the indiscriminate use of breastmilk substitutes in the developing world that is undergoing urbanization, industrialization, and increased employment of women is at this point at best a holding operation. On the positive side, the latest (2013) statistics from the Centers for Disease Control and Prevention’s (CDC’s) Breastfeeding Report Card2 note an increase in all the U.S. breastfeeding rates: initiation rate of 77%, exclusive breastfeeding rate at 3 months of 38% and at 6 months of 16%, with an “any breastfeeding” rate at 6 months of 49% and at 12 months of 27%. Better, but far from what is our ultimate goal.

However, when one peruses the statistics of the CDC’s Maternity Practices in Infant Nutrition and Care Survey3and notes that 55% of U.S. hospitals are still distributing infant formula discharge packs, one should not be surprised regarding this still very significant “drop off” of breastfeeding rates in the post-hospital period. Even more striking is the fact in the New England census region only 20% of the hospitals distribute formula discharge packs, whereas in the East South Central region 71% of hospitals distribute such packs, with the subsequent breastfeeding rates mirroring these numbers (i.e., the higher the discharge pack rate, the lower the subsequent breastfeeding rate!). Even more important is that the Survey documented that 50% of infants are routinely cared for by someone other than the parent (equally divided between licensed care setting and unlicensed care homes). Unfortunately, in only seven out of the 50 states did the state regulations for the licensed facilities meet the standards of being supportive for breastfeeding. Of course, no data were available for the unlicensed facilities. These numbers emphasize the need to focus on population-based public health policies and regulations (a role that the Academy of Breastfeeding of Medicine as the premier multidisciplinary physician-based organization can and should play as an experienced advocate and lobbyist) for creating the proper environment for breastfeeding support, not at the expense as to specific management issues for the individual mother–infant dyad but beyond.

The Academy of Breastfeeding Medicine, as we all know, sponsors Breastfeeding Medicine as its official journal and that the Journal is expanding to 10 issues a year! This is testimony that a professional, peer-reviewed journal of the highest scientific level was not only needed to provide a platform for the continuing expansion of our knowledge regarding human lactation and breastfeeding in all its aspects, but that in turn its existence would serve as the stimulus to further establish the field of breastfeeding medicine in the forefront of modern medicine and care. As such, the members of the Academy should take particular pride in their support of the Journal, both as members of the Academy per se and with their financial contribution to the support of the Journal through their dues.

As mentioned, the picture in the developing world is less encouraging. As examples, the repeated scandals in China of locally produced tainted infant formulas, the depletion of formula supplies in Australia as a result of large volumes of international formula brands that Chinese tourists bring home, the increased marketing of infant formulas in China by all the major manufacturers, and the public airing of the facts that formula makers are paying hospital staff across the nation to feed newborns infant formula before their mothers have an opportunity to breastfeed them are testimony that the process of modernization is resulting in a breakdown of traditional child-caring practices and a “golden” opportunity for the purveyors of infant formula to further their business goals rather than improve the quality of health care. It is just this type of development that the Academy of Breastfeeding Medicine in its professional capacity, armed with its scientific expertise and experience in dealing with governmental and public organizations, can and should align itself with the comparable groups in those countries. The invaluable asset of being a physician-based organization should not and cannot be minimized, and our voice should be heard worldwide.

Thus I thank all for giving me this opportunity to further the Academy’s mission and trust that any seeds that I planted will bear fruit with the proper nurturing of my successors.

REFERENCES

1. Midrash Tanhuma, Kedoshim, Vayikra Rabbah 25:5.

2. Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. Breastfeeding Report Card, United States 2013, National Immunization Surveys 2011 and 2012. Provisional Data.www.cdc.gov/breastfeeding/data/NIS_data/index.htm (accessed September 22, 2013).